Wyoming’s 1115 waiver application proposes to treat air ambulances like a public utility, with high fixed costs and universal service, and rely on free-market principles like competitive bidding and price transparency. Under the plan, Medicaid would: issue competitive bids; set up a centralized call center; make periodic flat payments to air ambulance providers; and articulate clear and transparent cost-sharing requirements. Though the state will assume short term risk to pay for this system, it will ultimately be self-funded. Health insurers would continue to cover air ambulance through up-front subscriptions or get billed by a state contractor on a fee-for-service basis. However, a Center on Health Insurance Reforms blog notes that the federal government still needs to approve the waiver proposal, after which Wyoming’s legislature would have to enact state-level legislative changes to enact the program.
Oklahoma’s legislature enacted HB 2351, entering the state into the Interstate Medical Licensure Compact (IMLC), effective November 1, 2019, reports The Oklahoman. The IMLC is an agreement among more than 25 states that allows qualified physicians to obtain expedited medical licenses in any compact-member state, reducing barriers to the provision of telemedicine services across state lines. This flexibility expands access to specialists for patients living in rural, frontier and other underserved areas.
Following months of negotiations, the contracts are set to expire between UnitedHealthcare and several University of Alabama Birmingham Health System entities this month, according to WSFA12. UnitedHealthcare claims that the UAB Health System is more expensive than other facilities – if no agreement is reached, UnitedHealthcare members who receive care at UAB facilities may be personally responsible for the cost of services received, though the emergency department at each hospital will remain open to members without additional out-of-pocket costs.
The state of Washington is praised for creating the country’s first “public option,” but a closer look at the law reveals tradeoffs that could curb potential savings for consumers, reports The New York Times. Although the law allows the state to regulate some healthcare prices, the prices were set significantly higher than drafters originally hoped in order to gain enough support to pass. As a result, the public option may not deliver the steep premium cuts that supporters want. Estimates suggest that individual market premiums will fall 5-10 percent when the new public plan begins.
Pennsylvania ranks 45th in the nation for per-capita public health spending, slightly ahead of Ohio, Kansas and Mississippi. The state spends $12 per capita on public health, according to data from the State Health Access Data Assistance Center (SHADAC). The data also show that state healthcare spending has been declining, going from $29 in 2005 to $13 per-capita in 2017. Though the state has made strides in fighting opioid and heroin abuse, funding for the public health component has remained flat. Other programs that enable people to live healthy and productive lives, such as General Assistance, were eliminated entirely, reports the Pennsylvania Capital-Star.
With the rising costs of healthcare concerning most residents, New Jersey may be surprised to learn it ranks as one of the most affordable when it comes to home healthcare, according to ROI-NJ. Using data from the U.S. Census Bureau, Genworth and the Centers for Medicare and Medicaid Services, SeniorLiving.org released a study describing that New Jersey patients spend nearly 72 percent of their annual household income on care inside the home. This score places New Jersey as 5th in the nation for most affordable home healthcare, while the national median percentage is 91 percent. Demand for home health aides is expected to surge through 2027, rising by 47 percent.
Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract (AQC) population health program with two-sided risk cut per-enrollee spending by as much as 11.9 percent compared to a control group, according to Healthcare Dive. Researchers from Harvard and Tufts University medical schools, Massachusetts General Hospital and Haven Boston, published a study in the New England Journal of Medicine looking at eight years of AQC data. Along with the cost savings, the quality of care improved – researchers saw a 7-percentage point increase in patients with diabetes receiving high quality disease management after the AQC program was implemented.
Rural and mountain region emergency medical services are trying just about anything to keep their money-losing ambulances running across Colorado’s rugged or remote terrain, according to The Colorado Sun. High costs, low reimbursement rates and scarce job applicants are forcing ambulance services to consolidate with fire responders, take on new tasks between emergency runs, and outsource fast-growing transport runs to bigger metro hospitals. Rural counties tend to have higher percentages of low-reimbursement insurance such as Medicare, Health First Colorado (Medicaid) or veterans care, making every ambulance run a money loser for the local hospital or emergency services district.
For the North Carolina Cherokee, self-governance has meant adopting an integrated care model designed by Alaska Natives to deliver care that not only improves patients’ health, but is also tailor-made for the needs of the tribe, according to Kaiser Health News. The Cherokee have opened a 20-bed hospital and have started construction on an 18-bed mental health clinic scheduled to open in 2020. Self-governance also allows tribes to be eligible for Medicare, Medicaid, private-sector health insurance, partnerships with larger health systems, and even federal grants that are designed for underserved communities – all of which can be limited for the Indian Health Service. Half of the Indian Health Service budget is now managed by Indian tribes to various degrees, but it remains to be seen how widely the full control, which has worked out well for tribes with resources like the Eastern Cherokee, can be applied. For instance, geographic isolation, poverty and a lack of resources make new healthcare investments difficult for tribes such as the Rosebud Sioux or the Oglala Lakota on the Pine Ridge Indian Reservation.
State Treasurer Dale Folwell reopened enrollment in the North Carolina State Health Plan with increases in how much medical providers could charge for their services, according to News & Record. According to the State Health Plan, the revision would increase what 727,000 current and retired state employees covered by the plan pay by $116 million. However, with coverage details for next year in limbo, thousands covered do not know for sure whether their local hospital and current medical providers will be in network or not. Folwell and the State Health Plan have been disagreeing with major health systems across the state, some of which have declined to enroll.